Provider Demographics
NPI:1215162060
Name:LOPEZ, ALBERTO (RPH)
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 DE MOTT CT
Mailing Address - Street 2:
Mailing Address - City:N MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1220
Mailing Address - Country:US
Mailing Address - Phone:516-292-9096
Mailing Address - Fax:
Practice Address - Street 1:1643 DE MOTT CT
Practice Address - Street 2:
Practice Address - City:N MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1220
Practice Address - Country:US
Practice Address - Phone:516-292-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist